001630 (ELEC)P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 53"533 hmmdda Villa LA QUINTA, CALIFORNIA 92253
Owner .-.
Tedl-lasmw BUILDING: TYPE CONST. OCC.'GRP.
Mailing
Address A.P. Number.
City Zip Tel.
... Legal Description
Contractor Project•Description
Address. ...•.
oe�� ,$)
City' Zip.. _ - Tela
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size - Stories Units
Arch., Engr:;
Designer .. New C;k Add ❑ Alter ❑. ' Repair ❑ Demolition
Address Tel.
City Zip State 4aler?d. L - and 209 am am.
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ' ' `3
7000) of, Division 3 of the Business and Professions Code, and my license is in full force and k -
effect.- .
SIGNATURE DATE .. ... .. -
• OWNER -BUILDER DECLARATION ` Estimated Valuation
hereby affirm that I am exempt from the Contractor's License Law for the following -
reason: (Sec. 7031.5,Business and Professions Code: Any city ot.county. which requires- a t.
permft=to construct, after, improve, demolish, or repair'any structure, prior. to :its issuance•. also.requires the applicant'for such permit to file..,a signed statement thathe.fs licensed pursuant to ' -PERMIT. "AMOUNT
the provisions of the Contractor's License Law, Chapter.9.(commencing with Section 7000) oL
'Divisiod 3 of'the Business and'Pro%ssions `Code, or -that: he is. exempi therefrom,and the basis .Plan• Chk. Dep.- '
for the. alleged exemption. Any violation of .Section 7031.5 by 'any applicant .for a permit'- -
'subjects the applicant.to a civil penalty ofnot more than five hundred dollars ($500). .: . ' - • '_ . -
O. I, as owner of the property, or my employees with wages as their sole compensation, will Plan .Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sea 7044; Buisness and C011St.,®.
Professions Code: The Contractor's License Law does -not, apply ;to an. owner of property who
builds or improves thereon and who does such work himself or through his- own employees, :-
, provided. that' such improvements are not intended or. offered Jor sale. If; . however, the'building Mech "
.or improvement is sold within one year of completion, the owner -builder will have the burden. Elecfflcal - ,ll,
of proving that he did not bufld-or fmprove /or the purpose of sale.)' ' - _
O I,.as owner of the property, am exclusively contracting.with licensed contractors to con- Plumbing
struct the project. -(Sec. 7044, Business and. Professions Code: The' Contractor's License Law• - ._.. .... .' -
does not apply to an owner 'of property who builds or improves thereon; and who contracts /or.-
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
O Iain exempt under Sec..--. . B: & P.C. for this reason
f` Driveway Enc.
Date _Owner.' tG`�� � �r Infrastructure
r�
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have' a certificate of consent to self -insure, .ora certificate' of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.):
Policy No: .Company.
❑ Copy.is filed with the city... O Certified copy is hereby furnished.
TOTAL
• CERTIFICATE OF EXEMPTION FROM. .- REMARK$
.WORKERS'.COMPENSATION INSURANCE.
(This section need not be completed i/ the permit is /or one hundred., dollars (S 100) valuation
or less.) . .. .. _
certify that in the performance of the work for which this permit is issued, I'shall not '
employ any-person'in any manner so as to' become subject to the Workers' Compensation - -
Laws of California.
' Date "Owner
NOTICE TO APPLICANT: 1/, after making this Certificate of- Exemption you should, .become ' •ZONE: BY: '
subject to"the' Workers'. Comperisalfon provisions of 'the .Labor Code, you .must forthwfth MIf11 R1Um Setback Distances: •'
comply with such provisions or this permit shall be deemed' revoked. - - -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Slde:Street- Setback from Center Line
I hereby affirm that there is'a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) : ' •. $Iris Setback from Property Line
Lender's .Name
Lender's Address
This isa building permit when properly filled out, signed and validated, and is subject to • FINAL,DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify :that I have read this application and state that. the above information is correct. Issued by: Date ...Permit .
auk&
agree to comply with all city and county ordinances and state laws. relating to building''
construction, and hereby authorise, representatives of this city to enter the above-.
mentioned property for inspection purposes. Validated b
Signature.of applicant Date ' •r « • .
Mail Address Vlltdatl0_ n:
M - '
City, State,, Zip
A1919 7 17 2250 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. 6
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND '
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
' FENCE FINAL
IN5Ft:U1 VK'S blUNAI UXt511N1I IALS,
GARDEN WALL FINAL